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The Any Occupation Standard: N.D. Cal.

05-14-2018, 11:07 AM

In a recent case from California, the court discusses the Any Occ. standard as it pertains to the Plaintiff. The Plaintiff in this case is a former software engineer who allegedly suffers from "chronic fatigue syndrome." The Plaintiff states that his condition limits his ability to perform daily tasks, but is much more manageable when he isn't held accountable to an alarm clock, stating: "I get up whenever I happen to wake up, which is nice. My symptoms tend to be quite a bit worse if I’m forced to get up ‘early’, after less sleep than I would have liked to get. Happily, that doesn’t happen too often these days."

The court reasoned through the case as follows:

The Court observes also that Nagy’s visits with Dr. Todd took on a different tenor after the Court remanded Nagy’s claim to Hartford to discern Nagy’s eligibility for Any Occupation benefits. From that point forward, Nagy’s treatment rationales and goals appeared to shift. Namely, Nagy raised his CFS with frequency, and sought referrals to see Dr. Snell of the Workwell Foundation and Dr. Montoya. This abrupt change is difficult for the Court to overlook. In that regard, the Court observes that Nagy repeatedly failed to implement the clinical recommendations of his treating physicians during the Any Occupation period. For instance, in both November 2015 and February 2016, Dr. Todd advised Nagy to adopt a gentle exercise routine. AR2 262, 266. He did not do so. Dr. Todd later explained to Dr. Bailey that Nagy exhibited a “consistent” pattern of noncompliance with her recommendations, including her suggestion that Nagy receive counseling. AR2 809, 761. Dr. Todd noted also that Nagy had “poor follow-through,” and failed to take his medications on a regular basis (often admitting that he did not do so upon questioning). AR2 809, 761; see Shaw v. Life Ins. Co. of N. Am., 144 F. Supp. 3d 1114, 1132 (C.D. Cal. 2015) (collecting cases, and finding that courts typically discredit a plaintiff “if she refuses treatment or is not diligent in following a treatment plan that could alleviate her symptoms”).

Ultimately, the court found that the Defendant was justified in denying the Plaintiff's LTD benefits claim under the Any Occ standard, and denied the Plaintiff's motion while granting the Defendant's. The opinion is attached below.